Why gender matters when it comes to stigma associated with addictions

Carolyn Shimmin is a Knowledge Translation Coordinator with the George and Fay Yee Centre for Healthcare Innovation and EvidenceNetwork.ca

From Chaucer to Shakespeare, women’s consumption of alcohol and other drugs has been historically written about and portrayed as an absolute affront to the dictates of socially-constructed ideals around “respectable femininity.” Girls and women living with substance issues are often falsely perceived as hypersexual and sexually promiscuous (i.e. as “sluts” and “loose”). Beneath the rhetoric that “good girls don’t imbibe” lies a dangerously entrenched stigma within our society that ― combined with the fact that two out of three Canadians don’t understand sexual consent as well as the codification of certain rape myths in law ― means the bodies of certain girls and women living with substance use problems become spaces where sexual violence can occur with impunity.

Moreover, a recent study found that young Aboriginal women in BC who use substances were nearly 10 times more likely to be sexually assaulted later in life if they had a history of childhood sexual abuse ― demonstrating how the stigma associated with women living with addictions often uses the very exact powerlessness and trauma born from early experiences of physical, emotional, sexual and/or psychological violence (by way of systemic gendered violence, racism and/or classism) that it is responding to in order to revictimize again and again.

Though the stigma against both men and women living with substance use problems is deeply entrenched in moral beliefs ― often referenced by people who hold negative assumptions about addictions issues in terms of a “lack of willpower” ― the stigma specifically aimed at Canadian girls and women is rooted in culturally-ingrained beliefs that substance use in the “fairer sex” leads to the undoing of morals within society (this, of course, from a culture that at once sexualizes young women and simultaneously “slut shames” ― a function of a rape culture that creates prohibited identities that can be policed and oppressed). Furthermore, the intersections of race and class, with the cumulative impact and unresolved trauma of the residential schools, adds yet another layer compounding the stigma and associated violence experienced by Aboriginal women living with addictions.

Yet the ratio of men to women in addictions treatment centres ― at a ratio of four to one ― has remained the same over years. Women are less likely to disclose, seek and access treatment for a myriad of reasons ― not only the stigma associated with taking up the label of “addict” ― but also barriers such as financial limitations, inaccessibility of child care and lack of services tailored to the specific needs of women, including trauma-informed approaches.

And statistics suggest that trauma may play an integral role when it comes to addictions issues in women ― with evidence that a large majority of women with substance use problems have experienced an early childhood sexual trauma. Such violence can bring about a sense of powerlessness, a loss of agency, a loss of self. And women may respond to this undoing in a variety of ways in order to make sense of it and to cope. They may employ both the ways in which they have been taught to respond to grief and loss as well as the options that are available to them at any given time. Girls and women who respond to such trauma by way of substance use may then be labeled as addicts. The stigma associated with this label using the very same violent loss to revictimize again.

As a society, there is a great reluctance to talk about, to deal with, to confront head on, grief and loss. When it comes to addictions, it is not about who is responsible and who should take responsibility, which is often what stigmatizing attitudes and behaviours associated with individuals who use substances thrives on. But rather it is about our collective “response-ability” when it comes to stigma associated with addictions in women and its link to gendered violence. Anti-stigma campaigns that use biomedical normalization approaches (i.e. “it is a disease just like diabetes”) ignoring the impact of gender, race, ethnicity, class, ability, sexual orientation and age (i.e. the very context of peoples’ lives), have been proven time and time again to be ineffective in changing negative beliefs and attitudes in the long-term. Until we begin to look at the complexities of all these interactions, the greatest loss of all for women living with addictions will be that of hope, healing and safety from violence.

The views and opinions expressed in this article are solely those of the author and do not necessarily represent those of Centre for Healthcare Innovation or EvidenceNetwork.ca